翼状胬肉的不同术式对创面上皮修复及复发率的影响

Comparison of clinical effects of three adjuvant therapeutics to primary pterygium excision

目的:比较羊膜移植、羊膜移植+丝裂霉素C处理和自体带结膜瓣的角膜缘干细胞移植等三种常见辅助治疗,对胬肉切除术术后角膜创面愈合和1a复发率的影响。方法:本研究为随机、单盲的前瞻性研究。选择160例190眼进展期翼状胬肉成年患者,在行胬肉切除手术时,随机辅助三种常见治疗:A组,羊膜移植(60例68眼);B组,羊膜移植+丝裂霉素C应用(50例62眼);C组,自体带结膜瓣的角膜缘干细胞移植(50例60眼)。随访、记录术后角膜创面愈合情况和1a复发率。结果:A,B和C三组患者角膜创面愈合时间分别为2.1±1.5,2.3±1.2和2.8±1.7d,以C组较长(P<0.05);A组术后2wk内有5例(7%)出现鼻侧结膜手术创缘肉芽肿生长,剪除后无再生,而B,C组未见创缘肉芽肿生长;术后1aA组11眼(16%)复发,与B组7眼(11%)和C组4眼(7%)相比较,具有统计学差异(P<0.05)。结论:羊膜移植+丝裂霉素C处理在促进术后角膜创面愈合和降低1a复发率疗效方面更有优势。

AIM： To compare clinical effects of three adjuvant therapeutics to primary pterygium excision. METHODS： This is a prospective, randomized, oneblinded trial. One hundred and sixty adult patients with advanced pterygium were randomly divided into amniotic membrane transplantation （ Group A, 68 eyes）, amniotic membrane transplantation and mitomycin C application （Group B, 62 eyes） and autologous corneal limbal stem cell transplantation with conjunctival flap （Group C, 60 eyes）. Patients were followed up until 12 months after operation. The corneal wound healing time and recurrence rate were analyzed. RESULTS： The corneal wound healing time was 2.1±1.5 days in group A, 2.3±1.2 days in group B and 2.8± 1.7 days in group C, respectively. The recurrence rate was 16% in group A, 11% in group B and 7% in group C, respectively. The recurrence rate was similar between group A and B. CONCLUSION： Amniotic membrane transplantation and mitomycin C application is more preferable in improving corneal wound healing and reducing postoperative recurrence after primary pterygium excision.